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The truth about Critical Illness & Mortgage Insurance Claims (Ontario)

I was just visiting my local bank. All across the banker’s desk were glossy flyers advertising critical illness and mortgage insurance. Behind the banker’s desk, there was a lovely poster which again, promoted critical illness and mortgage insurance.

The promotional material paints a very nice picture of what critical illness and mortgage insurance can do for you; should things go terribly wrong.


The narrative went something like this:

“I was diagnosed with terrible cancer…Thank goodness I had critical illness insurance with (Insert Name of Bank/Insurer here). Thanks to (Insert Name of Bank/Insurer here) I was able pay off my debts and live with dignity”.

The photo featured a happy and smiling family. Other photos showed a person who appeared to have a very serious and worried look on their face. Either way, these advertisements really drew on the heart strings.

In theory, critical illness and mortgage insurance policies are fantastic. In theory that is. When you get diagnosed with a “critical illness“, or with a “disability“, then your insurer will automatically pay out a lump sum cash benefit. No questions asked. This sounds great; doesn’t it!?

But in practice, many of these claims get denied.

One of the major barriers to recovery which our lawyers see is how claimants or their brokers complete the critical illness or mortgage insurance application form.

If you’ve never applied for insurance before, there are a lot of forms you need to complete before you get approved. The forms contain A LOT of questions about your pre-insurance health and wellness. These questions can be confusing, even for a personal injury lawyer.

Let’s take a look at some of these questions. Please keep in mind that these are actual questions which you are required to answer truthfully and honestly. The answers to these questions can be used to determine how much your premiums will cost; the answers can be used to approve or deny your policy; and/or the answers can be used to deny your claim after you’ve been accepted. Again, these are ACTUAL questions taken from an actual critical illness policy questionnaire from one of the major insurers/banks such as SunLife, Great West Life, Manulife, Industrial Alliance, RBC Insurance, TD Insurance, Equitable Life, Desjardins Insurance etc.

What was the date of your last medical consultation? You will need to remember this date, or call your doctor’s office to get that date. I personally cannot tell you the last time I saw my family doctor. Perhaps you have a better memory for these things than I do. Don’t guess!

Describe the symptoms which motivated this medical consultation? See my answer above. Same answer. Same memory problem.

Future tests recommended? I feel like I need my doctor present to answer this question. If I saw my doctor, I would only be able to harbor a guess; which would likely contain inaccurate medical information about the nature of the test ordered. 

Does your father, mother, brother(s), sister(s) or grandparents suffer from any have ever suffered from any of the following: cancer, heart disease, diabetes, polycistic kidney disease, mental illness, cerebrovascular disease, neurological conditions, ALS, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, Huntington’s Disease, hemophillia, or any other hereditary disorder? Not only do I need to be a good historian to answer this question, but I also need to interview my entire family and ALL of their doctors to answer this question properly. My family members also have to be good historians…Don’t guess!

Indicate whether you ever had symptoms, been told you have symptoms, sought medical attention or received treatment for any of the following:

  • Eye, ear, nose or throat disorders
  • Dizziness, fainting, convulsions, paralysis, neurological condition, ALS, multiple sclerosis, Alzheimer’s disease;
  • Shortness of breath, persistent hoarseness or cough up blood, bronchitis, pleurisy, asthma, emphysema, sleep apnea or other respiratory disorders
  • Chest pain, palpitations, high blood pressure, rheumatic fever, heart murmur, heart attack, angina, abnormal EKG, stroke, transient ischemic attack, dizziness, peripheral vascular disease, or ANY other disorders of the heart or blood vessels
  • Jaundice, intestinal bleeding, ulcer, colitis, hepatitis, carrier of hepatitis, Crohn’s disease, ileitis, or other disorders of the stomach, intestine, liver or pancreas
  • Sugar, blood, pus, protein in urine, stones or other disorders of the kidneys, bladder, prostate, or reproductive organs, sexually transmitted disease, breast disorder including lumps, cysts, other physical changes or abnormal mammogram findings or biopsy
  • Diabetes, thyroid or other endocrine disorders
  • Lupus, neuritis, arthritis, rheumatism, gout or other disorders of the bones of muscles
  • Pain or discomfort in back, neck or any joint. If yes, then how many times. Date of first occurrence. Date of last occurrence. Cause
  • Physical deformity, amputation, lameness or disability
  • Cancer or tumor, cyst, polyp, mole, mass or growth, lump, skin or lymph gland disorders
  • Anemia, immunodeficiency or other blood disorders
  • Exposure to AIDS, hepatitis B and/or C virus
  • Fatigue, anxiety, depression, burnout, mental disorder or any other nervous or psychiatric or psychological disorder
  • Chronic fatigueLondon Head Shot Brian Goldfinger

Do you ever watch American television, when they have commercials from large pharmaceutical companies promoting new drugs and medication?  At the end of the ad, a deep voice speaks very quickly and lists all of the side effects of the medication being advertised. This question is akin to that sort of advertisement. I cannot think of a single person who hasn’t had any “symptoms” or hasn’t “sought medical attention”  or had any “treatment” for the laundry list cited above. If you are one of those people, please let me know. I simply don’t know where to begin with this all encompassing question which hits every health problem known to mankind. 

If you answer “NO” to all of the above, and you have to make a claim on the policy, chances are your claim will get denied. The reason for the denial is because that laundry list of health symptoms above is so all encompassing, it’s virtually impossible that your critical illness won’t be tied to one of the answers you’ve provided.

The rationale for the denial may sound something like this:

Dear John Doe Claimant:

Thank you for submitting your critical illness (or mortgage insurance) claim to (Insert Name of Large Insurer or Bank here).

We have reviewed your application along with the additional medical documentation you have provided.

The information obtained was cross referenced against your Member’s Questionnaire. We have found a number of discrepancies which include, but aren’t limited to:

Your answer to question A was marked in the negative

Your answer to question B was marked in the negative

Your answer to question C was marked in the negative

Based on the medical information provided to us, these questions ought to have been marked in the positive. This information ought to have been disclosed to the Company’s attention in order to adequately assess the Application for Insurance. If this information had been provided as it should, the critical illness coverage would not have been accepted as requested.

Taking into account the above, the critical illness (or mortgage insurance) protection has been denied, and your policy has been cancelled.

If you wish to appeal this decision, please contact our Ombudsman.

Yours truly,

An insurance company laughing all the way to the Bank


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